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Non-stenting treatment versus endoscopic stent placement in staple line leaks after laparoscopic sleeve gastrectomy

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Abstract

Purpose

Presentation of results of non-stenting treatment versus endoscopic stenting placement in gastric staple leaks after laparoscopic sleeve gastrectomy (LSG).

Methods

Between January 2007 and August 2020, 1371 eligible patients underwent LSG. After gastric leak detection, patients were classified into treatment groups A (endoscopic stent placement) and B (non-stenting management). Overall hospital stay, the time to complete gastric leak resolution and the incidence of further operative management constituted the main outcome measures. Statistical analysis included descriptive statistics and linear regression tests as needed.

Results

A total of 27 patients (19 F/8 M, median age: 44.8 years (range: 36–58) with median preoperative BMI: 43.5 kg/m2 (range: 37.0–48.7)) presented with gastric staple line leak (1.9%) — mean detection day 5.8 postop (range: 1–12). Eight patients enrolled in group A and 19 patients in group B. The mean hospital stay for group A was 41.2 days (range: 24–60) versus 15 days (range: 12–18) for group B (p < 0.001). Complete leakage resolution was observed at mean 42.4 days (range 25–60) for group A and 34.5 days (range: 28–40) for group B patients, (p = 0.025). Only 2 group A patients accomplished complete leak resolution without additional intervention. Five group A patients (62.5%) versus 4 group B patients (21.1%) needed operative intervention during the treatment course (p = 0.037).

Conclusions

Conservative, non-stenting treatment of staple line leaks after LSG is feasible and is associated with superior results in terms of hospital say and leak resolution in comparison to endoscopic stenting.

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Availability of data and material

Authors, Andreas Kiriakopoulos MD, Nefeli Kounatidis MS, Menenakos Ilias, Kostrova Maria MD, Zografos Konstantinos MD, Evangelos Menenakos MD, declare that the data of the study are available upon reasonable request.

Code availability

Authors, Andreas Kiriakopoulos MD, Nefeli Kounatidis MS, Menenakos Ilias, Kostrova Maria MD, Zografos Konstantinos MD, Evangelos Menenakos MD, declare that all software applications are available upon reasonable request.

References

  1. Angrisani L, Santonicola A, Iovino P et al (2018) IFSO worldwide survey 2016: primary, endoluminal, and revisional procedures. Obes Surg 28:3783–3794. https://doi.org/10.1007/s11695-018-3450-2

    Article  PubMed  Google Scholar 

  2. Salman MA, El-Ghobary M, Soliman A et al (2020) Long-term changes in leptin, chemerin, and ghrelin levels following Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy. Obes Surg 30(3):1052–1060. https://doi.org/10.1007/s11695-019-04254-z

    Article  PubMed  Google Scholar 

  3. Kalinowski P, Paluszkiewicz R, Wróblewski T, Remiszewski P, Grodzicki M, Bartoszewicz Z, Krawczyk M (2017) Ghrelin, leptin, and glycemic control after sleeve gastrectomy versus Roux-en-Y gastric bypass-results of a randomized clinical trial. Surg Obes Relat Dis 13(2):181–188. https://doi.org/10.1016/j.soard.2016.08.025201618

    Article  PubMed  Google Scholar 

  4. Gagner M, Hutchinson C, Rosenthal R (2016) Fifth International Consensus Conference: current status of sleeve gastrectomy. Surg Obes Relat Dis 12(4):750–756. https://doi.org/10.1016/j.soard.2016.01.022

    Article  PubMed  Google Scholar 

  5. McTigue KM, Wellman R, Nauman E, Anau J, Coley RY, Odor A et al (2020) Comparing the 5-year diabetes outcomes of sleeve gastrectomy and gastric bypass: the National Patient-Centered Clinical Research Network (PCORNet) Bariatric Study. JAMA Surg 155(5):e200087. https://doi.org/10.1001/jamasurg.2020.0087

    Article  PubMed  PubMed Central  Google Scholar 

  6. Kichler K, Rosenthal RJ, DeMaria E, Higa K (2019) Reoperative surgery for non-responders and complicated sleeve gastrectomy operations in patients with severe obesity. An international expert panel consensus statement to define best practice guidelines. Surg Obes Relat Dis 15(2):173–186. https://doi.org/10.1016/j.soard.2018.11.006

    Article  PubMed  Google Scholar 

  7. Gagner M, Buchwald JN (2014) Comparison of laparoscopic sleeve gastrectomy leak rates in four staple-line reinforcement options: a systematic review. Surg Obes Relat Dis 10(4):713–723. https://doi.org/10.1016/j.soard.2014.01.016

    Article  PubMed  Google Scholar 

  8. Chen B, Kiriakopoulos A, Tsakayannis D, Wachtel MS, Linos D, Frezza EE (2009) Reinforcement does not necessarily reduce the rate of staple line leaks after sleeve gastrectomy. A review of the literature and clinical experiences. Obes Surg 19(2):166–172. https://doi.org/10.1007/s11695-008-9668-7

    Article  PubMed  Google Scholar 

  9. Nedelcu M, Skalli M, Delhom E, Fabre J, Nocca D (2013) New CT scan classification of leak after sleeve gastrectomy. Obes Surg 23(8):1341–1343

    Article  CAS  Google Scholar 

  10. Csendes A, Burdiles P, Burgos AM, Maluenda F, Diaz JC (2005) Conservative management of anastomotic leaks after 557 open gastric bypasses. Obes Surg 15:1252–1256

    Article  Google Scholar 

  11. Burgos AM, Braghetto I, Csendes A, Maluenda F, Korn O, Yarmuch J et al (2009) Gastric leak after laparoscopic-sleeve gastrectomy for obesity. Obes Surg 19:1672–7

    Article  Google Scholar 

  12. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, Bellomo R, Bernard GR, Chiche JD, Coopersmith CM, Hotchkiss RS, Levy MM, Marshall JC, Martin GS, Opal SM, Rubenfeld GD, van der Poll T, Vincent JL, Angus DC (2016) The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 315(8):801–810. https://doi.org/10.1001/jama.2016.0287

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Bhattacharjee P, Edelson DP, Churpek MM (2017) Identifying patients with sepsis on the hospital wards. Chest 151(4):898–907. https://doi.org/10.1016/j.chest.2016.06.020

    Article  PubMed  Google Scholar 

  14. Abou Rached A, Basile M, El Masri H (2014) Gastric leaks post sleeve gastrectomy: review of its prevention and management. World J Gastroenterol 20(38):13904–13910. https://doi.org/10.3748/wjg.v20.i38.13904

    Article  PubMed  PubMed Central  Google Scholar 

  15. Berger ER, Clements RH, Morton JM, Huffman KM, Wolfe BM, Nguyen NT et al (2016) The impact of different surgical techniques on outcomes in laparoscopic sleeve gastrectomies: the first report from the metabolic and bariatric surgery accreditation and quality improvement program (MBSAQIP). Ann Surg 264:464–73

    Article  Google Scholar 

  16. Stroh C, Köckerling F, Volker L, Frank B, Stefanie W, Christian K et al (2016) Results of more than 11,800 sleeve gastrectomies: data analysis of the German Bariatric Surgery Registry. Ann Surg 263:949–955

    Article  Google Scholar 

  17. Yolsuriyanwong K, Ingviya T, Kongkamol C, Marcotte E, Chand B (2019) Effects of intraoperative leak testing on postoperative leak-related outcomes after primary bariatric surgery: an analysis of the MBSAQIP database. Surg Obes Relat Dis 15(9):1530–1540. https://doi.org/10.1016/j.soard.2019.06.008

    Article  PubMed  Google Scholar 

  18. Mumtaz H, BaroneGW KBL et al (2002) Successful management of a non-malignant esophageal perforation with a coated stent. Ann Thorac Surg 74:1233–1235

    Article  Google Scholar 

  19. Salinas A, Baptista A, Santiago E et al (2006) Self-expandable metal stents to treat gastric leaks. Surg Obes Relat Dis 2:570–572

    Article  Google Scholar 

  20. Iannelli A, Schneck AS, Ragot E, Liagre A, Anduze Y, Msika S et al (2009) Laparoscopic sleeve gastrectomy as revisional procedure for failed gastric banding and vertical banded gastroplasty. Obes Surg 19:1216–1220

    Article  Google Scholar 

  21. Shehab H (2018) Enteral stents in the management of post-bariatric surgery leaks. Surg Obes Relat Dis 14(3):393–403

    Article  Google Scholar 

  22. Swinnen J, Eisendrath P, Rigaux J, Kahegeshe L, Lemmers A, Le Moine O, Devière J (2011) Self-expandable metal stents for the treatment of benign upper GI leaks and perforations. Gastrointest Endosc 73(5):890–899. https://doi.org/10.1016/j.gie.2010.12.019

    Article  PubMed  Google Scholar 

  23. Schiesser M, Kressig P, Bueter M, Nocito A, Bauerfeind P, Gubler C (2014) Successful endoscopic management of gastrointestinal leakages after laparoscopic Roux-en-Y gastric bypass surgery. Dig Surg 31(1):67–70. https://doi.org/10.1159/000358849

    Article  PubMed  Google Scholar 

  24. Morell B, Murray F, Vetter D et al (2019) Endoscopic vacuum therapy (EVT) for early infradiaphragmal leakage after bariatric surgery—outcomes of six consecutive cases in a single institution. Langenbecks Arch Surg 404:115–121. https://doi.org/10.1007/s00423-019-01750-9

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We, authors: Andreas Kiriakopoulos MD, Nefeli Kounatidis MS, Menenakos Ilias, Kostrova Maria MD, Zografos Konstantinos MD, Evangelos Menenakos MD, declare that no other personal assistance has taken place in creating this work.

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Author notes

  1. Andreas Kiriakopoulos

    Present address: 5th Surgical Clinic, “Evgenideion Hospital”, National and Kapodistrian University of Athens School of Medicine, Papadiamantopoulou 20 Str., PO: 11528, Athens, Greece

Authors and Affiliations

  1. 5th Surgical Clinic, “Evgenideion Hospital”, National and Kapodistrian University of Athens School of Medicine, Papadiamantopoulou 20 Str., PO: 11528, Athens, Greece

    Nefeli Kounatidis, Konstantinos Zografos & Evangelos Menenakos

  2. Actuarial Science, Department of Statistics, London School of Economics, London, UK

    Ilias Menenakos & Maria Kostrova

  3. 1st Clinic, Division of Morbid Obesity and Metabolic Surgery, “Ippokrateion Hospital”, National and Kapodistrian University of Athens School of Medicine, Athens, Greece

    Evangelos Menenakos

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Contributions

Andreas Kiriakopoulos: study conception and design, analysis and interpretation of data, drafting of manuscript, critical revision of manuscript. Nefeli Kounatidis: acquisition of data, drafting of manuscript. Menenakos Ilias: study conception and design, acquisition of data, analysis and interpretation of data. Kostrova Maria: study conception and design, acquisition of data, drafting of manuscript. Zografos Konstantinos: acquisition of data, drafting of manuscript, critical revision of manuscript. Menenakos Evangelos: study conception and design, acquisition of data, analysis and interpretation of data, drafting of manuscript, critical revision of manuscript.

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Correspondence to Andreas Kiriakopoulos.

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Authors, Andreas Kiriakopoulos MD, Nefeli Kounatidis MS, Menenakos Ilias, Kostrova Maria MD, Zografos Konstantinos MD, Evangelos Menenakos MD, declare that all participants have consent to this research study.

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Authors, Andreas Kiriakopoulos MD, Nefeli Kounatidis MS, Menenakos Ilias, Kostrova Maria MD, Zografos Konstantinos MD, Evangelos Menenakos MD, declare that we consent to the publication of our research study.

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Kiriakopoulos, A., Kounatidis, N., Menenakos, I. et al. Non-stenting treatment versus endoscopic stent placement in staple line leaks after laparoscopic sleeve gastrectomy. Langenbecks Arch Surg 407, 1863–1872 (2022). https://doi.org/10.1007/s00423-022-02498-5

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